Provider Demographics
NPI:1730352907
Name:PODIATRY IN MOTION, INC.
Entity type:Organization
Organization Name:PODIATRY IN MOTION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HEIRING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-862-4732
Mailing Address - Street 1:1046 N WOOD ST
Mailing Address - Street 2:#1-R
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-7273
Mailing Address - Country:US
Mailing Address - Phone:773-862-4732
Mailing Address - Fax:773-862-4732
Practice Address - Street 1:1046 N WOOD ST
Practice Address - Street 2:#1-R
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-7273
Practice Address - Country:US
Practice Address - Phone:773-862-4732
Practice Address - Fax:773-862-4732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004846213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001632315OtherBLUE CROSS
IL0001632315OtherBLUE CROSS
ILU68119Medicare UPIN